Download Mastoiditis - Queensland Otology

Professor Bruce Black MD
Dr Jane Black PhD
MASTOIDITIS
The middle ear cleft is not only the air-filled chamber behind the eardrum, but rather an aerated system
extending from the Eustachian tube into the tip of the mastoid bone behind the ear. Within the mastoid is a
honeycomb of air-filled tiny chambers (air cells) that function as a pressure buffer system to help the air
adapt to rapidly changing air pressure situations.
This aerated bone system may be prone to infection in several situations. Virulent bacteria from the nose
may enter during upper respiratory infections, particularly in young infants whose immunity remains relatively
under-developed. Alternatively, infection may enter via a perforated drum, or if chronic disease such as
cholesteatoma perpetuates infection. Should the infection access the air cells, acute or chronic infection may
result. The lining of the cells becomes inflamed, with debris accumulating and bone infection complicating
the situation.
Acute Mastoiditis: Acute, painful pinna protrusion.
Characteristics
Acute Mastoiditis is generally found in infants, complicating acute bacterial middle ear infection; a lesser
number in older aged groups arises from cholesteatoma. Rapidly developing infection in an infant may
rupture through thin overlying bone just above and behind the external ear canal, forming a reddened and
swollen abscess that pushes the ear outwards. Pain is severe, with deafness and general malaise. A single
protruding ear with pain and possible discharge, in an infant, is classic presentation for acute mastoiditis.
Chronic mastoiditis is characterised by persistent mucoid discharge from a drum perforation. Deafness is
present, but the ear may be otherwise free of symptoms. Generally the problem persists despite antibiotic
treatment.
“Silverton Place”
101 Wickham Terrace
Brisbane Qld 4000
P: 07 38397677
F: 07 38325723
Other Locations
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Sunnybank
Mt Ommaney
Caboolture
Professor Bruce Black MD
Dr Jane Black PhD
Treatment
Surgery is the norm for these conditions. In sudden onset disease in infants, acute mastoid infection may
succumb to drainage with/without grommet insertion, plus intensive antibiotic treatment. Chronic mastoiditis
cases, and many acute episodes, demand surgery to clear the infected bone thoroughly, removing the
infected cells by high speed drilling back to healthy tissues. In expert hands the surgery is generally effective
in a short period.
Disease clearance is achieved via an incision behind the ear (simple or cortical mastoidectomy), but
recovery is usually rapid, without major discomfort or complications.
In adult cases the possibility of concurrent cholesteatoma cannot be ignored.
More information
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AOM Complications
“Silverton Place”
101 Wickham Terrace
Brisbane Qld 4000
P: 07 38397677
F: 07 38325723
Other Locations
Beenleigh
Sunnybank
Mt Ommaney
Caboolture